Healthcare Provider Details

I. General information

NPI: 1073093035
Provider Name (Legal Business Name): GELSOMINO AND DAVIS SPEECH AND OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TRIANGLE RD STE C
LIBERTY NY
12754
US

IV. Provider business mailing address

PO BOX 923
LIBERTY NY
12754-0923
US

V. Phone/Fax

Practice location:
  • Phone: 845-747-2580
  • Fax:
Mailing address:
  • Phone: 845-747-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 845-747-2580